The Role of Residential Care Settings in Delivering Long-Term Services and Supports

Residential care settings are community-based care settings for individuals who are unable to live completely independently. Licensed by states using different definitions, residential care settings include both small group homes and large assisted living communities and most frequently provide personal care services.

This presentation reviews work by RTI International under contract to MACPAC, to gain a better understanding of the role residential care settings play in delivering home and community-based services (HCBS) to Medicaid beneficiaries. This work included inventorying state Medicaid coverage and payment policies for services provided in residential care settings and case studies of four states to understand issues that affect beneficiaries’ access to these settings.

The presentation also discusses policies that could affect beneficiary access to this community-based option, including 2014 HCBS settings regulations, adoption of managed long-term services and supports, and payments for community-based settings when eligibility determinations are delayed.

MACPAC

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About MACPAC

MACPAC serves as an independent source of information on Medicaid and CHIP issues that include payment, eligibility, enrollment, coverage, access to and quality of care, and the programs' interaction with Medicare and the health system generally. MACPAC’s authorizing statute requires it to submit two reports to Congress annually. The Commission holds public meetings and consults with state officials, congressional and executive branch staff, beneficiaries, health care providers, researchers, and policy experts to carry out its work.